Update on negotiations with Salem Health administrators

We know that our negotiations with Salem Health may cause inconvenience for our members, particularly those who need to find new doctors. Our Customer Service and Care Management teams are working directly with members who call to ensure they continue to receive the care they need from in-network providers who value our commitment to high-quality, affordable care.

We want to reinforce that members in treatment with Salem Health providers for serious or complex conditions continue to have access to Salem Health doctors and nurses at in-network rates and benefits for a limited period of time. If you believe you qualify for continued in-network care, please call us at the number on the back of your member ID card.

We met with Salem Health administrators this morning in hopes of making progress toward a long-term agreement for in-network access to medical care for our members at a fair and sustainable cost.

Once again, we were disappointed at Salem Health’s demands for unrealistic reimbursement increases, only this time we calculate their ask to be a still-staggering 40% increase over a two-year period, coming down from a 50% increase over the same time frame (an estimated 35% in year one and 15% in year two).

As a nonprofit, local health plan, our insurance premiums directly reflect the cost of health care. While we appreciate Salem Health's willingness to continue negotiations, our members and the employer groups who pay to provide health care to their employees cannot afford a 40% increase in what they pay to access Salem Health providers.

We understand costs go up and we have consistently provided Salem Health increases that account for increased costs of doing business. We believe doctors and nurses should be fairly paid for the care they provide. We regularly negotiate with health systems to ensure our members continue to have in-network access to high-quality care at an affordable price. Most of our negotiations end in agreement. It’s the standard for our industry. It is not a game. We would ask Salem Health administrators not treat it as such.

We appreciate the patience and support we have received from our members and local employer groups who would be hit the hardest by a 40% increase in the cost of care. We will continue to hold the line on costs and do hope Salem Health’s administrators consider the impacts their demands would have on the local community we both serve.

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Previous update from Jan. 10, 2025

Salem Health chose to leave the Regence network of providers and facilities on Jan. 1, 2025. That means if Regence members continue to see Salem Health providers and facilities, they could pay more. There are some exceptions:

In a medical emergency

Regence members should go to the nearest hospital. Care for an emergency medical condition will be covered as in-network (even if you don’t otherwise have out-of-network benefits), though your out-of-pocket costs will vary depending on your health plan benefits.

If you qualify for continuity of care

If you’re currently being treated by a Salem Health provider for a serious or complex condition, you may qualify for continued care for a limited time at in-network benefits and rates.

The federal No Surprises Act protects consumers from unexpected bills from out-of-network providers

The No Surprises Act protects people with current health insurance coverage from receiving surprise medical bills when they receive most emergency services from out-of-network providers. People with Medicare and Medicaid already enjoy these protections and are not at risk for surprise billing. Under the Act, consumers are protected from unexpected bills from providers in the following circumstances:

• Emergency room visits, even if received from out-of-network providers and without pre-authorization
• Air ambulance services (charges by ground ambulance services are not currently protected under the No Surprises Act.)
• Certain additional services (like anesthesiology or radiology) furnished by out-of-network providers as part of a patient’s visit to an in-network facility

The prohibitions on surprise billing for air ambulance, emergency and non-emergency services only apply to items or services that are covered benefits under the in-network terms of your health plan. Members can’t be charged more than in-network rates for these services.

Be aware, out-of-network providers may ask members to give written consent to balance bill

In limited situations, the No Surprises Act allows some out-of-network providers and facilities to get written approval from patients to voluntarily waive their protection against balance billing for post-stabilization services after an emergency room visit.

If you have any questions about your ability to receive care from a provider without receiving surprise bills, please call us at the number on the back of your member ID card. We’re here to help you.

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Previous update from Dec. 31, 2024

As of Jan. 1, 2025, Salem Health providers and facilities are no longer part of the Regence network. That means if our members continue to receive care from Salem Health, they will likely pay more.

Salem Health’s leadership has refused to back down from their request in September for an increase of an estimated 35% in what we pay them to care for our members in 2025.

We are disappointed that Salem Health’s leadership has chosen this path. If Salem Health's leadership is willing to entertain a reasonable proposal, we will continue to negotiate in hopes of bringing them back in network for the patients and members we jointly serve.

As a reminder, our network includes other regional providers who share our commitment to high-quality, cost-effective health care, listed at the bottom of this blog. This is not a complete list, nor are these providers available through all plans. Please call the number on the back of your member ID card so we can redirect you to an appropriate in-network care provider.

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Previous update from Dec. 20, 2024

Despite our best efforts to reach a fair and reasonable agreement with Salem Health on the cost of care, we remain at an impasse. Salem Health’s administrators have not moved from their demand for an estimated 35% increase in what we pay them to care for Regence members.

Salem Health acquires Willamette Urology

Salem Health announced on its website that it bought Willamette Urology on Dec. 16, 2024. This means that Willamette Urology doctors and facilities will also be out of network for Regence members on Jan. 1, 2025, if Salem Health chooses to leave our network.  

This negotiation does not affect access to the Salem Clinic

Salem Health and Salem Clinic are not affiliated. Regence members will continue to have in-network access to Salem Clinic doctors and facilities even if Salem Health leaves the network.

If you are in a current course of treatment with Salem Health or Willamette Urology

Please call us at the number on the back of your member ID card and we can help to determine if you are eligible for continued in-network access to care for a limited time from these providers after Jan. 1, 2025.

We understand the disruption this causes for our members and we are committed to helping our members move their care to in-network provider systems that value our commitment to high quality care at an affordable cost.

If we do reach agreement before year end, we will update the news here.

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Previous update from Nov. 26, 2024

As negotiations continue, we want to make sure our members are prepared if Salem Health leaves our network at the end of the year.

Regence members may continue to access Salem Health providers and facilities at in-network rates through Dec. 31, 2024.   

We maintain a strong network of hospitals, facilities and primary and specialty providers in Oregon. Regence members may find in-network providers by signing in at regence.com and selecting Find Care, using the Regence app, or calling customer service at the number on the back of their member ID card.

Members undergoing current treatment may qualify for what’s called “Continuity of Care,” and are urged to call customer service at the number on the back of their member ID card. 

Do I qualify for Continuity of Care (CoC)? 

To qualify, members need to be undergoing a course of treatment or scheduled to undergo nonelective surgery with Salem Health. Examples of conditions that may be considered include but are not limited to: 

• Inpatient admissions, including acute hospital and behavioral health levels of care 
• Transplant 
• Pregnancy in the second or third trimester 
• High-risk pregnancy, in any trimester 
• Cancer treatments 
• Trauma 
• Behavioral Health diagnoses with regular visits with specialist providers
• Terminal illness 

How long does CoC last? 

For non-pregnancy related conditions, the CoC clock starts when the member is notified of a termination by letter or phone and will last for either 120 days, or the day after a final course of treatment is completed if that’s sooner than 120 days. For pregnancy-related care, CoC will end either on the 45^th day after birth, or 120 days after the member is notified of a termination, whichever comes first. 

For Medicare Advantage members, CoC lasts for 90 days after the date of termination, March 31, 2025, in the case of Salem Health.   

Again, Regence members should call the number on the back of their member ID card if they believe they may qualify for CoC.

What if I’m experiencing an emergency?

Members may receive emergency care, including being in active labor, at in-network rates at any hospital regardless of network because of the federal No Surprises Act. Out-of-pocket costs will vary depending on your health plan benefits. The Act protects members from surprise bills for most emergency services, even if they were received from out-of-network providers and without prior authorization. 

Previous update from Oct. 25, 2024

Despite weeks of discussion, the leaders of Salem Health have held firm on their demand for what we estimate to be a 35% increase in what they get paid to provide care to Regence patients in 2025, and an additional 15% in 2026.

A 35% increase in what we pay Salem Health for care would:

• Increase an emergency room visit by more than $1,000
• Increase the cost of a c-section by about $7,600 and
• Result in an estimated increase in the cost of a knee replacement by a whopping $17,600

We are disappointed that Salem Health’s leadership has chosen this path, which now requires us to formally notify Regence members who have used Salem Health in the past year that the provider will likely be leaving our network on Jan. 1, 2025.

We have tried several times to engage Salem Health’s leadership to support our members who are in an active course of treatment to transition their care to other in-network providers, but they have refused to work with us to support these members. If Salem Health leaves our network, members currently receiving care from Salem Health providers may have the right to continue in-network treatment for a limited time after Jan. 1, 2025. Eligible conditions include but are not limited to:

• Seeing the provider for a serious or complex condition, including certain chronic conditions
• Undergoing a course of institutional or inpatient care from the provider
• Being scheduled for nonelective surgery from the provider
• Being pregnant and seeing the provider for pregnancy-related care
• Being determined to be terminally ill

Members who may be eligible for continuing care are urged to call us at the number on the back of their member ID card. For members who are receiving care from Salem Health and would like to explore their options to move their care to another in-network provider, please call us. We’re here to help.

Below is a short list of alternative providers. For a complete list, please sign in at regence.com and select Find Care. Or call us for help finding an in-network provider near you.

Type	Provider
Acute Care Services	Silverton Hospital
	Santiam Hospital
	Samaritan Albany General Hospital
	Legacy Meridian Park Medical Center
Primary Care Services	Salem Clinic
	Willamette Family Medical Center
	South Salem Primary Care (Praxis)
	Silver Creek Family Medicine
	West Salem Family Practice Associates
	Primary Care West
	Family Medicine LLC

 

We will update this article as negotiations unfold.

 

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Previous update from Oct. 4, 2024

Salem Health’s leadership made the unnecessary decision to issue early public notice regarding our contract negotiations, even though our contract extends another three months through Dec. 31, 2024.

Regence members may continue to access Salem Health providers and facilities at in-network rates through Dec. 31, 2024.

Between 30-45 days before a contract ends, insurers are required to notify members of a possible termination. Contract negotiations between insurers and provider systems happen all the time and most resolve before public notice is required. This saves needless concern for the people we jointly serve.

The recent announcement by Salem Health’s leadership well before any required public notice unnecessarily alarms Oregonians. This is a tactic some provider systems use to influence public opinion and pressure insurers to agree to unreasonable rate increases.

In this case – based on our calculations – Salem Health is demanding an increase of an estimated 35% in what they get paid for care. Considering the state’s 3.4% Cost Growth Target and the economic forecast of a less than 3% income increase for Oregonians in the coming years, this demand is both unconscionable and outrageous. This demand is down from the initial estimated 41% demand for increases in treatment costs.

We negotiate the cost of care on behalf of our members and employer groups to maintain access to high-quality, affordable care. As a tax-paying nonprofit, our premiums and out-of-pocket costs for medical care directly reflect what providers charge. Our members and employer groups simply cannot afford a 35% increase in what they pay to access care at Salem Health, nor should they have to.

We await further discussions from Salem Health as we attempt to negotiate in good faith, but they have not signaled a willingness to do so.

It is true that Salem Health’s doctors and facilities are important to our network and our members, but we also maintain a strong network in Oregon with ample access. This includes Oregon Health & Science University, Legacy Health, Silverton Memorial Hospital, Samaritan Albany General, Santiam Hospital, the Salem Clinic, South Salem Primary Care, Willamette Family Medical Center, Silver Creek Family Medicine, West Salem Family Medicine, Primary Care West, Family Medicine LLC, and hundreds of other primary and specialty providers.

We will continue to update this article as conditions change. If you are a Regence member and have any questions or need help finding a new provider, please call us at the number on the back of your member ID card. We’re here to help.